=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194076000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL PRATT DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2012
-----------------------------------------------------
Last Update Date | 10/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6434 N COLLEGE AVE SUITE D
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46220-6602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-251-5812
-----------------------------------------------------
Fax | 317-251-5885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6434 N COLLEGE AVE SUITE D
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46220-6602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-251-5812
-----------------------------------------------------
Fax | 317-251-5885
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL PRATT
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 317-251-5812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 08001789A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------